CAPM:: Canadian Academy of Pain Management

CME Record of Participation

To claim additional credits from CAPM not already claimed through your professional organization or regulatory body, the following form is provided to guide your submission.

Name of course, conference, research project (note this does not include private journal reading hours)

Dates of Event:
Places:
Sponsoring Organization:
Total Hours Attended:

What were your learning goals in undertaking this CME?

What new knowledge or skills did you learn?

In your practice, how would you attempt to apply this new knowledge or skill?

How will you and evaluate your success in implementing this new knowledge or skill?

If claiming a publication or a teaching presentation, please list a copy of the paper or lecture notes, including references, or experts consulted.

www.aapainmanage.org
www.canadianpainsociety.ca
www.iasp-pain.org